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01/12/2011 14:07 FAX C�7j002 <br /> _, , <br /> 4fr // �b <br /> 313 =r80 -00 <br /> City of Zephyrhilis'Fir•-e Fax- 813 -780 -0021 <br /> Permit Application <br /> Phone Contact for Permit <br /> Gas ussasastaggegrE" Da s Receiw_d __ - 1 $ 3 G26 5482 <br /> Owner's Phone Number 1 <br /> 04 nets Name ITMPTIRXCRTNNET L . <br /> Ov'nersAddress I 4701. Oak Fair Blvd TAMPA FL 33610 . <br /> - Mel - wider Phone Number 1 I <br /> Fe a Simple Titleholder Prams <br /> Fe SimpieTitteholder Address I <br /> Jo ) Address I .. ... <br /> MS OffliBassonlogimegga <br /> 1 � 9)44\ �j . PM1 ittS V,. 355Li2 40,Ptivr'i1'dis (iris Lot# <br /> Parcel # _ � <br /> Si b Division : ., • <br /> t3io-l•iazard Waste Storage - ANNUAL <br /> Fumigation Tent <br /> a Comm Extiaust'Kitchen Hood/Duct I I Hazardous Material (Tier It or RQ Faciity) ANNUAL • <br /> Li' • Controlled Bum I 1 Hood Installation • [ 1 LPM atural • Gas - installation . <br /> Emergency Generator < 30 kw LP/Natural Gas-ANNUAL Sate <br /> . Generator > 30 •kw I I <br /> r es of Asse <br /> I I Pieces .. )e �l <br /> �:?' °; Firs Protection Mairrtenance =AhiNUAL . <br /> - . r y C, ., 1 An i (6�:L / <br /> Sprinkler'. I r [ ❑ CI ... - I I Recreational Bum • ? ! ,�/� / <br /> ; , : ,. Are Alarm , n Cl ❑ 1:1• I• , I , n Spariders . 1 /// n1/ /C� ' <br /> ' -'. Hood I 0 ' . ' 0 . J � s <br /> ' 1 Sp rinkler • <br /> System lnstaliatioiid ` <br /> �js <br /> d I C 4 0 l 1 Standpipes (Sprinkler Sys); - <br /> - � , . . ` ; Hgod &uf+plessio • • . _ <br /> .3; , ' r tq. F <br /> '`- ire Arlarm l nstal)ati on - -. Toroh RooiinVTar l4ttt�` .. .. • ' . fi <br /> ';'' ! _.... -..._. _ ...,_- .r,_.,.,__... Tire Storage ANNUM: . <br /> :. Fi Pump � blasts ! IT.... / ip <br /> , .` : ` Fire Works • : j Valuation of Project <br /> ,N' • ®. •:, Flammable Application- ANNUAL I • . - t <br /> Al • Other <br /> r 1 Company .- eery 1( <br /> C �n ature 1.:;'. Registered Y/ N Fee current I / N 1 ' • <br /> S gnafure : -"t -tu -.F.- <br /> • Add ,��ggii ss w � i <br /> • EL t � : "'' a , . .: r' r Y1•N, E. '. 'a-Y /Jh <br /> . � rs' •' ;"•, . ..4 R691Sten9d •' ... � f =.. �. t '� t; ' • ' � ' � <br /> Ad T , License • <br /> # . '. t '„ ( . <br /> Company. z, / ;p: ; <br /> F LUMBER Registered . YIN 'I Fee CGrrettt L Y % 1:' £ ignaWre • I <br /> ( License # • 1 <br /> • ' Address I • Company <br /> E i gna ure Registered Y / N I Fee Current I Y/ N I <br /> ' •: igrrattire I � f License* - <br /> . <br /> address {x °tx • <br /> • <br /> C THER . ' - I <br /> Company . . <br /> l (gnature Registered Y / N I Fee Current L Y /11, .I <br /> - <br /> License # _ <br /> Address I <br /> IV (recta • . • • <br /> Fill out application completely- ed contract with owner) <br /> Owner R Contractorsign back of application, notarized (Or, copy of sign <br /> `� . - = if over $2590, a'Notice of Commencement is required_(Mechanicat work over $5000) . <br /> . •_ • . Supply Iwo (2) sets of drawings With appticab(e documentation <br /> r ; ";_ » :.- - . - _Altai( 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Nonce (httpffappraiser.pascogov.corn) • <br /> r: , <br /> . . _ <br /> e <br />